It’s perhaps the most common complaint people have about any hospital. You come in to the Emergency Department registration area, give some identification and a description of your problem, and hope to be seen promptly. You are sick, or in pain, and certainly not in the mood to “hang out” with a crowd of other sick people. Misery may love company but not in the ED waiting room. So what’s behind the wait?
If you arrive in critical condition you will be seen as quickly as possible. Life and death situations get top priority. We’ll keep that in mind as we proceed. If you are able to come in on your own through the ED entrance, you will register then go to the triage area. You can usually get to triage fairly quickly, but if it’s very busy, there will be a wait. People often arrive at the ED in clusters, which can take time to work through. In triage, a provider will obtain some details on what’s wrong and take your vital signs. Maybe some lab work will be drawn or an imaging procedure will be ordered. After that, things become more variable.
Sometimes, an exam room may be available right away and you may go there next. If you have a critical condition, or if you are in great distress, you will be prioritized and seen immediately. If the ED is busy and if your condition is not critical and allows it, you will usually return to the waiting room until any lab or imaging work is completed and a staffed exam room becomes available.
This is often when a wait may seem too long. You may feel like your care is on hold, but the test results are being processed and interpreted behind the scenes. Your care is progressing although you aren’t seeing it happen. Other patients are also being taken care of out of sight in the treatment area. When your results are in, and a room is empty and clean, it will usually be your turn. However, sometimes others who arrived after you may have to be seen first.
While prioritization makes sense to us conceptually, it’s sometimes hard to accept that our condition may not rank as high as someone else’s. But life-threatening emergencies and serious acute conditions take precedence over survivable illness and injury. And sometimes they happen in a cluster. ED people always have to take care of those who are critically ill first.
Other factors: ED’s often have to modify their care processes to incorporate new techniques and changing standards, some of which add more time to their patients’ ED visits. Additional time may also be needed to see if a patient responds to a period of treatment before deciding on discharge. And behavioral health patients, some of whom become violent with staff, often need constant staff attendance in an exam room for many hours.
These issues do not excuse ED’s from functioning as efficiently as possible. There is often room for improvement. Physicians and staff members want to minimize waiting time because of its impact on patients’ care and experiences. No one chooses a career in one of the highest stress, least appreciated roles in healthcare so they can annoy people. They regularly analyze data, including patient surveys, to look for ways to improve. However, there are still times when more patients need emergency care than can be handled and waits may occur despite best efforts.
The writer is chief medical officer at University of Maryland Charles Regional Medical Center.